Provider Demographics
NPI:1730210956
Name:CAVE RUN PHARMACY INC
Entity type:Organization
Organization Name:CAVE RUN PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHEYENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-783-1511
Mailing Address - Street 1:255 OLD FLEMINGSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1090
Mailing Address - Country:US
Mailing Address - Phone:606-783-1511
Mailing Address - Fax:606-783-0075
Practice Address - Street 1:255 OLD FLEMINGSBURG RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1090
Practice Address - Country:US
Practice Address - Phone:606-783-1511
Practice Address - Fax:606-783-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12663336C0002X, 3336C0003X
KYPO1266333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5401575500Medicaid
KY90011032Medicaid
KY90011032Medicaid